GISN - VRI, CART and Captioning Services Request Form

GISN - Request for VRI, CART, and Captioning Services

Note: if your event takes place in less than 48 hours or if you have not received that your request was processed within two business days, please call us for immediate assistance at (800) 228-4992 or (404) 521-9100.
Do you have an existing GISN Customer agreement AND a VRI/CART/Captioning addendum agreement signed with GISN?*

YesNo
If you answered no, you must contact request@gisn.info in order to complete the GISN Customer agreement and/or the VRI addendum before requesting a service.
Your Agency Name*
Authorized Requester Full Name*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Type of Service Requested*

CART (Verbatim Text)Real-Time Hybrid Captioning (TypeWell/C-Print)Closed CaptioningTranscriptionVideo Remote Interpreting (VRI)Unsure - please help!
Does your Organization use any of the Following?*

SkypeZoomAdobe ConnectBluejeansGoToWebinarGoToMeetingWebExConference dial-inBlackboardOther
Event Details
Event Start Date*

MonthDayYear
Event End Date*

MonthDayYear
Start Time (If you think that it will start early or go longer than planned, please account for that in your scheduling time.)*

Hour Minutes

AM/PM Option
End Time (If you think that it will start early or go longer than planned, please account for that in your scheduling time.) *

Hour Minutes

AM/PM Option
If your event has different start and end times, list them here.
General Subject Matter of Event/Class (for example, math class, Financial meeting, webinar, anatomy lecture)*
Name of Deaf or Hard of Hearing Consumer*
Nature of Appointment (Webinar, Medical Appointment, Employee Meeting, etc.)*

Please indicate the # of participants present at appointment/ conference/ training, etc.:*

	Deaf/Hard-of-Hearing	Hearing	Deaf/Blind
Adults
Minors (17 and under)

Name of Audio/Visual or Tech person and contact information*
Please upload any copies of PowerPoint, Agenda, and materials used during the meeting.

Cancelof
Please paste the access link to the meeting: *
For Captioning Request
Requesting for pre-recording or LIVE?:
Person of contact (name and contact information for Interpreters to contact for more information)
After hours phone number*
Please enter a valid phone number.
Billing Information
Billing Information*
Billing Contact Full Name*
Billing Contact Phone*
Please enter a valid phone number.
Billing Contact Email*
example@example.com
Please Note: GISN would like to get your approval/declined should the interpreters continue past the requested time, at any time an approval is granted, interpreters will continue until the event is finished. The requested time will be adjusted. Please reply with your consent or decline for interpreters to continue.
P.O. Box 2945, LaGrange, GA 30241

www.gisn.info
Should be Empty:

GISN - Request for VRI, CART, and Captioning Services

Event Details

For Captioning Request

Billing Information

P.O. Box 2945, LaGrange, GA 30241